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Phone: 0207 222 4877
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Which Centre would you like to attend

What are your preferences for appointment dates, times

Name( * )

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Email( * )

Date of Birth (DD-MM-YYYY)

Mobile number

Funding Body Customer reference number

The nature of your disability

Your University name

Level of Study

Is your course full time or part time

Course name

Course end date

Year of Study

Assessments are sometimes observed for training purposes, please tick here if it is ok for your assessment to be observed

We need copies of the following documents in order to confirm a booking:

your Medical Evidence / Psychologist report

Your Funding Body letter (DSA1) that says, ‘Now you need to book a Study Needs Assessment.’

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